Just Read: Can Physicians Manage the Quality and Costs of Health Care? The Story of the Permanente Medical Group

To know where you’re going, it’s important to know where you came from….

This book, published in 1991, gives a physician’s eye view of one of the most significant health movements in the United States – prepaid, integrated health care with a social mission.

Before reading the book, I already knew that part. I didn’t appreciate its scope in American consciousness, though:

On one occasion, Avram Yedidia, the Health Plan representative, observed a distinguished looking man working quietly on some papers while waiting for an appointment with his physician at the Permanente Hospital in Oakland….Yedidia asked him if he were satisfied with the medical attention he was receiving from the Plan. The gentleman said that he was. Yedidia then asked if he minded the waiting. No, he did not, the gentleman replied. He understood how busy the doctor was. Yedidia then introduced himself, and asked the man’s name. He was Enrico Fermi, a professor of physics at UC Berkley and a winner of the Nobel Prize.

A few more quotes about the genetic code, revealed in the book:

On April 14, 1941, the first keel of the first freighter, the Ocean Vanguard, was laid…that freighter was the first of 1490 vessels to be constructed in Kaiser Shipyards over the next 5 years. in the case of the Robert E. Peary, launched in November, 1942, less than 1 year after Pearl Harbor, the time between keel laying and launching was reduced to 7 days, 14 hours and 29 minutes.

This level of social organization and cooperation was matched by a program of medical care equally organized and disciplined. The intense social cooperation of the shipyards inspired and sustained a practice of medicine comparably characterized by innovation and social cooperation. When it was over, a new way of practicing medicine had emerged.

As early as April 4, 1945, Sidney Garfield outlined them (the genetic code) in a speech to the Multnomah County Medical Association in Portland, Oregon

(here they are, summarized)

Prepayment

Group practice

Adequate facilities

A new economy of medicine (“By having the healthy pay to maintain their own health, capital coaslesced with which to care for the sick”)

Voluntary enrollment with dual choice

Physician responsibility in management as well as medical matters

Medical education, not a new idea…

There was even talk of establishing a medical school in San Francisco after the Stanford Medical School moved south to Palo Alto.

Kaiser Permanente did not mature with ease. There were lots of conflicts along the way, detailed in the pages throughout. This is in large part why people who say the core element is prepayment don’t understand what Kaiser Permanente is.

In the end, this is the place people came to. The answer to the question in the title is an unqualified yes.

No matter how the principles of our plan our meant…if you don’t have the physician group who have it in their hearts to make it work and who believe in prepaid practice, it won’t work. This is the thing that makes me wonder about HMOs all over the country. They aren’t going to work unless they get men in those operations who really believe in giving service to the people. – Sidney Garfield, MD

I am suggesting, (Cecil) Cutting reported to the partnership on October 13, 1969, that they not put their foot in it unless they can put their heart in it also. That is, first to be convinced of the principles, philosophy, and desire to provide good medical care at reasonable cost – to take pride being part of an organization that is making the medical dollar go a little bit farther.